Editor-at-Large George Lundberg explores the online, real time "publication" of clinical outcomes of individual "trials" via a new open source community.

Hello. I'm Dr. George Lundberg speaking for my colleagues at Cancer Commons, Marty Tenenbaum and Jeff Shrager, and this is At Large at MedPage Today.

We are now 15 years into the Medical Web and much progress has been realized. We are closer to "science at the speed of thought" than we have ever been. BioMedCentral, PubMedCentral, the Public Library of Medicine (PLoS/Currents), the Cochrane Collaboration, Medscape (with the revolutionary experimental Medscape Journal of Medicine), eMedicine and, more recently, MedPage Today, continue to lead the way.

Obviously, the great search engines and Wikipedia, along with social media and topical Internet communities, have sparked acceleration and demand.

Much as these have begun to change the way we think about how to interact with biomedical knowledge, there is much more that can be done. Medical Journals are soooo 20th (or 19th or 18th) Century.

Now we can build rapid learning communities where clinicians and researchers can post clinical observations, anecdotal case reports, hypotheses, and preliminary but actionable research findings that are too early for formal presentation in journals or at conferences, but may be helpful to late-stage patients running out of options.

Physicians and patients can report clinical outcomes and side effects from these "N of 1" experiments through the Web, which can then be aggregated to rapidly test the posted hypotheses.

Treatments that prove successful in a few patients can be generalized to a specific molecular phenotype, and validated in proof of concept studies or small clinical trials. If they hold up, they can ultimately get incorporated into the guidelines as the new standard of care. Hypotheses and observations that don't hold up can be quickly rejected or revised based on the data points from human subjects.

This translational loop can run in real time, so that what is learned from one patient can be disseminated in time to help the next, taking years off of the standard path from an observation to a trial to a publication or conference presentation, to incorporation into formal practice guidelines.

In cancer, for example, we are creating a real time, open source science community called Cancer Commons.

At the core of Cancer Commons are interactive models of molecular pathways hyperlinked to relevant references, trials, tests, and treatments.

At each point in time, patients can be treated with the best available therapies for their tumors' molecular subtype. Studying how different patients respond to the same therapies will likely lead to splitting existing subtypes, corresponding to responders and nonresponders, or adding new ones to accommodate previously unseen tumor types.

Over time, subtypes in the reference model will be defined with greater and greater specificity and linked to increasingly efficacious therapies.

These dynamic models are in effect LIVING REVIEW ARTICLES, maintained online and continuously updated by the cancer community. Postpublication peer review and online revision are fundamental parts of the model creation process.

We at Cancer Commons will make these processes an accountable constant by requiring the identities of the reviewers/critics/contributors to be shared with us, the initial authors, and the READERS. No more anonymous reviewers and editors like most of the big journals or like Wikipedia seems to the average reader.

In addition, because of the unique nature of molecular oncology, the time is ripe for LIVING CASE REPORTS.

No longer will an author have to wait until some distant outcome to publish; no more would a physician have to wait years to learn about a case that might be immediately helpful in their practice, or wonder what happened to a patient after the case was published.

Additional LIVING ARTICLE categories will evolve.

The future is now. Watch Cancer Commons from CollabRx grow.

That's our opinion.

At Large for MedPage Today, we are George Lundberg, MD, Marty Tenenbaum, PhD, and Jeff Shrager PhD.